Podiatry Management Online


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From: Jeffrey M. Robbins, DPM


It is gratifying to see at least some comments on my original call for a single board. It is painfully obvious that change is hard and opinion strong on this topic. However, the future requires growth and development; otherwise it stays stagnant which will move us backward as the rest of the progressive world passes us by. We are only as good as our weakest link. Let’s make sure we have a high standard and strengthen all the links in our chain, keeping in mind that we are a procedure-based profession regardless of the simplicity or complexity of those procedures.


Jeffrey M. Robbins, DPM, Cleveland, OH

Other messages in this thread:



From: Jeff Root


Dr. Udell asks, “Should we deal with any orthotic lab that is owned by podiatrists, and is actively marketing their orthotics and training to chiropractors, physical therapists, and other non-podiatric professionals?" As the owner of an orthotic lab that doesn’t market to other specialties, I believe that podiatrists should do what they believe is in the best interest of their patients, even if that means using an orthotic lab that markets to other specialties. 


That said, I know of no other specialty that possesses the level and depth of education and training in non-surgical and surgical treatment of the foot and ankle and who also can provide other critical diagnostic tests and treatment such as imaging, prescription drugs, etc. While there are some individuals in other specialties who are very capable of providing good quality foot orthotic therapy, they do not possess the same range and quality of services that a podiatrist can provide. It is unfortunate that many consumers and patients do not understand the difference in the qualifications between podiatrists and other providers of foot orthotic therapy. That is why it is important to educate the public so they can determine who may be the best provider for their foot and ankle care.


Jeff Root, President, Root Lab, Inc.



From: Allen Jacobs, DPM


Dystrophic nail changes may be secondary to repetitive micro-trauma. Mallet toe and hallux hyperextension deformity are common examples of such etiologic factors. Fungal infection may occur as a comorbidity or without associated trauma. Dermatopathology laboratory testing can, in many cases, establish the fungal and or traumatic etiology and therefore suggest treatment options. I would suggest that such testing would be considered prior to EHL tenotomy for "spoon toe". Perhaps dermoscopy or other studies in the future will prove helpful.


Additionally, whether performed distal to the extensor hood or not, the development of flexion deformity of the hallux IPJ and hallux hammertoe are possible over the long-term. It seems appropriate to provide long-term clinical outcomes showing the absence of such iatrogenic deformity. Ultrasound, MRI, or other studies demonstrating re-establishment of the continuity and function of the EHL would also be appropriate. Long-term study of the eventual result with reference to the toenail appearance, texture, associated pain, etc. would also be helpful.


Dr. Katzen correctly notes that treatment of onychomycosis with laser therapy or the use of oral antifungals is not typically appropriate absent confirmatory testing. Furthermore, as noted by Dr. Katzen, any traumatically induced contribution to the observed nail dystrophy should be recognized and appropriate intervention offered to the patient. The induction period for iatrogenic deformity is not always immediate. Short-term success will not guarantee long-term success. 


Allen Jacobs, DPM, St. Louis, MO



From: Richard M. Cowin, DPM


Back in the 1980s, the federal government announced that they were seeking Preferred Practice Guidelines (PPGs) (aka Clinical Practice Guidelines) for all medical specialties for their National Guidelines Clearinghouse. In this announcement, they went one step further and stated that if the various medical specialties groups didn’t produce these on their own, the government would produce these documents for them. Doctors were rightfully concerned about how these untrained and informed bureaucrats might draft these documents and to their credit, many medical specialty groups went on to produce such guidelines.


The first podiatry organization to research, draft, and submit their PPGs to the National Guidelines Clearinghouse and to have such guidelines approved was the American College of Foot & Ankle Surgeons. However, the Board of Trustees for the Academy of Ambulatory Foot Surgery (now the Academy of Minimally Invasive Foot and Ankle Surgery) under the leadership of their then president, now prominent healthcare attorney, Lawrence Kobak, DPM, JD, felt that...


Editor's note: Dr. Cowin's extended-length letter can be read here.



From: Robert Scott Steinberg, DPM


Sorry, Dr. Trench, but I can't agree with your ideas! I own the foot. You want me to only own part of the foot. Added to that, we will spend the next 50 years explaining our fractured-in-half profession to patients and physicians. That's not going to happen. The residency program at Norwegian American Hospital, headed by Louis Santangelo, DPM, teaches both podiatric medicine and surgery. We have a three times a week foot and ankle clinic at the hospital. Residents also rotate through attendings' offices. In addition, Norwegian American Hospital hosts a twelve-slot family practice residency program, giving our podiatric residents further immersion in medicine. 


So, be careful before you break something.


Robert Scott Steinberg, DPM, Schaumburg, IL



From: Dieter J Fellner, DPM


Dr. Epstein asks: “it is recommended that diabetic patients should have a baseline ABI performed? Recommended by whom, I ask?” 


Answer: The American Society of Vascular Surgery recommends that any diabetic patient aged 50+ should have baseline ABIs.


We perform ABIs accordingly and have the vascular surgery team visit the office for follow-up, as necessary.  


Dieter J Fellner, DPM, NY, NY

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